1. Health Informatics its role, importance and a historical perspective (why should I care ?) David Parry, School of Computing, AUT

3. Agenda  Where did Health informatics come from ?  What does it do ?  Why should I care ?

4. Why you can’t keep up.... Number of clinical trials published in PUBMED 1975 -2011 per year

5. Informatics is  Information-centred not computer centred  Based on getting clinical value from information  (Very) important in primary care  A support for administration and workflow as well as clinical activity  A New Zealand Success story

6. History  Informatics deals with handling information  Recorded Observations Hippocrates(460-370 BC) Index Medicus – John Shaw Billings 1879

7. The broad street pump John Snow August 1854,

8. Computers arrive...

9. Moore’s law

10. People and computers 1 million years BC

11. History  Internet started in 1960s – to protect networks in the case of nuclear warfare.  World Wide Web – suggested in paper published in 1988.  Browsers early 1990’s  19.2 Billion webpages in 2005  Most users now access WWW via mobile devices.

13. What does Health Informatics do ?  Successful areas of Health informatics include:  Reminder systems  Electronic health records  Data repositories  Coding, Ontologies and vocabularies  Data sharing  M/Uhealth

14. Essentially.... Sharing Collecting Storing Analysing Presenting Information

15. Medicine needs records

16. Problems with paper

18. Electronic Health Records  Present in effectively all GP surgeries, and most DHB’s

19. “Five uses of clinical data” (MOH) Data collected should be available for:  Supporting clinical intervention  Clinical Governance  Administration (in all parts of Health)  Strategy and policy development  Research

20. The sixth use ?  Patient (consumer) self-management and self care.

21. Decision support  Use data from Electronic record, combine with rules  Reminders – eg high blood pressure, protocols  Decision Analysis – need utility values

22. Recall and health management  Cervical Screening, Contraceptive Pill  Blood pressure, diabetes  Paediatric checks  Moving into..  Community care  Telehealth

23. The Central Paradox of CaseMIX  Every patient is different…  BUT we want to compare them.. So we code them

24. Why use a vocabulary ? example…  Pre-eclampsia  Gestational Proteinuric Hypertension  Toxaemia  GPH  PET  PE  All the same all map to.. pre-eclampsia 398254007 - code

25. SNOMED CT

26. Why is coding difficult ?  Experts don’t agree – even when a loose standard of agreement is required (Chiang 2006)  SNOMED CT is very large and changes by 5-10% each release  Data is used in ways that might be unfamiliar to the originator Reliability of SNOMED-CT Coding by Three Physicians using Two Terminology Browsers Michael F. Chiang, John C. Hwang, Alexander C. Yu, Daniel S. Casper, James J. Cimino, and Justin Starren AMIA Annu Symp Proc. 2006; 2006: 131–135.

27. Presenting Information -Access (distance) to health care Population (by territorial authority) more than 30 minutes from a GP; using LCPA (least cost path algorithm) http://www.nzma.org.nz/journal/117-1199/996/

28. Sharing : Messaging :HL 7  Health level 7  Initial version going back to 1987  Extensive use around the world, and since 1994 in New Zealand

29. Why messages ?  No communication electronically at all – life is difficult  Shared universal record – so far impossible c.f. connecting for health UK  Messaging – send standard, relevant pieces of information between electronic systems.

30. Pharmacy Labs GP Hospital Messages and the n(n-1) Problem

31. Recall and health management  Cervical Screening, Contraceptive Pill  Blood pressure, diabetes  Paediatric checks  Moving into..  Community care  Telehealth

32. Mobile and ubiquitous health

33. Pill dispensing Counts pills dispensed Wireless device

34. Why should I care ?  Informatics needs clinical input and clinical problems to work on.  Good solutions come from clinical involvement  If clinicians don’t get involved...

35. What not to do...

36. Keep Hardware Secure

37. Keep data secure

38. Questions ? Dave.parry@aut.ac.nz

39. Useful information sources  HINZ – www.hinz.org.nzwww.hinz.org.nz  IMIA - http://www.imia.org/http://www.imia.org/  Health IT cluster :http://www.healthit.org.nz/http://www.healthit.org.nz/  National Health IT board: http://www.ithealthboard.health.nz/ http://www.ithealthboard.health.nz/  HISA (Australia)- http://www.hisa.org.au/http://www.hisa.org.au/  RACGP ehealth site: http://www.racgp.org.au/ehealth http://www.racgp.org.au/ehealth